Pandemic-Era Household Stress Hit Nearly Half of Pregnant Women

A cross-sectional analysis of national surveillance data has found that family and household stressors were the most common pandemic-related challenge faced by pregnant women in the United States, with significant disparities by race, ethnicity, marital status, and socioeconomic status. The study, published in Public Health in Practice, analyzed 2020-2021 PRAMS COVID-19 supplement data from 28 US jurisdictions, representing a weighted sample of 453,231 women who had recently given birth.¹

Investigators used factor analysis to group 22 self-reported pandemic experiences into 5 constructs: family household stressors, housing instability, trouble accessing COVID-19 prevention measures, COVID-19 exposure within the household, and exposure to others outside the home. The analysis aimed to fill a gap in nationally representative data describing how pregnant women experienced the pandemic beyond documented increases in maternal morbidity and mortality.¹

Family Stress and Housing Instability Were Widespread

Family household stressors—the most prevalent factor identified—affected 42.1% of women at a high level and an additional 35.1% at a medium level. The most commonly reported individual experience was feeling more anxious than usual (48.5%), followed by spending more time caring for children or other family members (36.0%) and losing a job or having hours or pay cut (29.9%).¹

Housing instability affected 11.3% of women, including 10.8% who had to move or relocate and 2.0% who became homeless during pregnancy. The authors noted that this homelessness rate was 10 times higher than the general US population rate of approximately 0.2%.¹

More than one-third of respondents (35.2%) reported at least 1 negative experience obtaining COVID-19 prevention supplies, and roughly 1 in 10 women reported a COVID-19 diagnosis within their household. Exposure to others outside the home—through work responsibilities or a household member's job—was reported by 68.5% of women.¹

Disparities by Race, Ethnicity, and Socioeconomic Status

Significant differences emerged across demographic groups. Black (48.5%) and Hispanic (48.0%) women reported the highest prevalence of high-level family household stress, compared with 31.2% among Asian women, the lowest rate observed. Housing instability was most prevalent among American Indian/Alaska Native (21.6%), Black (19.5%), and Hispanic (15.5%) women.¹

Hispanic women also reported the highest rate of trouble accessing COVID-19 prevention measures (40.1%), and COVID-19 infection within the household was most frequent among American Indian/Alaska Native (22.8%) and Hispanic (19.2%) women.¹

Unmarried women experienced higher rates of household stressors (51.2% vs 36.8%) and housing instability (17.4% vs 7.3%) than married women. Women with a high school education or less, those enrolled in Medicaid before pregnancy, and urban residents also reported higher rates of household stressors and housing instability than their counterparts.¹

Health-Related Vulnerabilities Compounded Stress

Women who experienced interpersonal violence during pregnancy reported the most severe pandemic-related challenges: 67.7% reported high family stress (vs 41.4% among women without violence), and 31.6% reported housing instability (vs 10.5%). Women with unintended pregnancies also reported greater family stress (52.8% vs 36.4%), housing instability (15.6% vs 8.8%), and household COVID-19 exposure (14.3% vs 9.7%) than those with intended pregnancies.¹

Pre-pregnancy depression was linked to markedly higher family stress (63.0% vs 38.2%) and housing instability (19.6% vs 9.6%), though women with pre-pregnancy depression were less likely to report exposure to others outside the home (67.5% vs 73.3%). Women with pre-pregnancy overweight or obesity reported higher family stress, greater household COVID-19 exposure, and—notably—greater engagement in COVID-19 prevention behaviors than women without these conditions.¹

Implications for Prenatal Care and Pharmacy Practice

The study authors called for emergency preparedness protocols that go beyond traditional prenatal care models to address pregnant women's social support infrastructure, including housing assistance, expanded childcare services, and guaranteed access to prevention resources. They also emphasized integrating mental health screening into routine prenatal and postpartum care and implementing universal violence screening protocols in prenatal settings.¹

Pharmacists are often a first point of accessible contact for patients navigating exactly the kinds of barriers identified in the study, including difficulty obtaining hand sanitizer, disinfectant, and masks, which affected more than one-third of pregnant respondents.¹

A related clinical review in Seminars in Pediatric Neurology similarly underscored the evolving guidance pharmacists and other health care professionals have had to communicate to pregnant and lactating patients over the course of the pandemic, including updated recommendations from the American College of Obstetricians and Gynecologists supporting COVID-19 vaccination for all pregnant, recently pregnant, and lactating women without trimester-specific restrictions.²

That review also noted that vaccinated pregnant women showed antibody responses and safety profiles similar to non-pregnant vaccinated women, along with evidence of passive antibody transfer to infants via cord blood and breast milk.²

Taken together, the findings point to a need for coordinated, family-centered support that extends beyond the clinic, with the PRAMS authors specifically citing Medicaid expansion and culturally responsive interventions as tools for protecting vulnerable pregnant populations during future public health emergencies.¹

REFERENCES

1. Williams A, Danielson RA, Osei MA. Pregnant women's experiences during a public health emergency: A cross-sectional analysis of the COVID-19 Pregnancy Risk Assessment Monitoring System COVID-19 supplement. Public Health Pract (Oxf). 2026;12:100832. Published 2026 Jul 24. doi:10.1016/j.puhip.2026.100832

2. Twanow JE, McCabe C, Ream MA. The COVID-19 Pandemic and Pregnancy: Impact on Mothers and Newborns. Semin Pediatr Neurol. 2022;42:100977. doi:10.1016/j.spen.2022.100977